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This starts with the virus mostly infecting animals, with a few cases where animals infect people, then moves through the stage where the virus begins to spread directly between people, and ends with a pandemic when infections from the new virus have spread worldwide and it will be out of control until we stop it.

A disease or condition is not a pandemic merely because it is widespread or kills many people; it must also be infectious.

For instance, cancer is responsible for many deaths but is not considered a pandemic because the disease is not infectious or contagious.

In a virtual press conference in May 2009 on the influenza pandemic, Dr Keiji Fukuda, Assistant Director-General ad interim for Health Security and Environment, WHO said "An easy way to think about pandemic … Then you might ask yourself: 'What is a global outbreak'?

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Global outbreak means that we see both spread of the agent …

and then we see disease activities in addition to the spread of the virus." In planning for a possible influenza pandemic, the WHO published a document on pandemic preparedness guidance in 1999, revised in 2005 and in February 2009, defining phases and appropriate actions for each phase in an aide memoir entitled WHO pandemic phase descriptions and main actions by phase.

The 2009 revision, including definitions of a pandemic and the phases leading to its declaration, were finalized in February 2009.

The pandemic H1N1 2009 virus was neither on the horizon at that time nor mentioned in the document. The phases are defined by the spread of the disease; virulence and mortality are not mentioned in the current WHO definition, although these factors have previously been included.

One of the most devastating pandemics was the Black Death, which killed over 75 million people in 1350.

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